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To handle this question I prefer to give you the edited version (i.e. the tech that has been tested, passed by the authorities and in use currently in certain dental practices).

CadCam Restorations

First developed almost 30 years ago and seen many evolutions since, this technology allows the dentist to produce chair-side crowns and inlays digitally without the need to use conventional impressions or dental laboratories.

It works like this:

Tooth/teeth preparation is carried out in the conventional way; a digital scanner is used to 3-dimensionally scan upper and lower teeth;

this information is processed and modified on a screen by the clinician; this information is used to mill the restoration (inlay, crown, bridge) from a shade-matched ingot

by small automated milling unit within the same practice.

After milling the restoration is put into a furnace for blasting. In theory, most restorations will be ready to fit within 1-2 hours.

Pros: Quick – Claimed to take 1-2 hours time compared to 1-2 weeks in a laboratory. This is not always true though. Most systems can take up to half a day to complete.

Your clinician is making the restoration, not a lab technician in another city. Therefore any mistakes can be rectified much faster. Your dentist also knows what he/she wants for you; so communication errors are minimal since there is no need to write, call or email the technician.

Cons: Proficiency of your clinician is dependent on his/her experience with the machines.

These machines are very expensive, therefore your dentist may charge more for these CadCam milled restorations (also potential for overprescription of these restorations over conventional fillings).

Some dentists argue that high level aesthetics on front crowns are still only possible with human technicians.

Summary

These units are still rare among UK dentists. The cost can approach 55-80 thousand pounds. The success of restorations produced in this way is not always 100%. The first scanner units to be produced required the teeth to be completely dry and coated with a powder spray before a successful scan could be completed. That is no longer required. Similarly, other areas of CAD CAM systems are becoming more user-friendly every year. But the system is far from fully automated and may take some time to become just that.

It has been a long standing debate within our profession on which is the better choice for the patient – Private or NHS dentistry. The answer is subjective. It depends on what the customer demands and requires. And these needs are changing rapidly within our population.The expected quality of service is finally starting to play a role in the our industry.

The perception of luxury and the feel-good factor are now becoming commonplace in the service industry. And dentistry’s borders are expanding to become part of this service industry. The quality of the delivered product and the method of delivery are role to play in the patient’s choice. Pain-free dentistry is not the only requirement now, as it once used to be.

The question is simple. Is it only about the cost ? Why choose a Mercedez when there are cars that are far cheaper that will provide you the same transport. Or why fly to the Bahamas when Spain is much closer with good weather ?

It is what is expected from the service and the choice in products that differ. Or at least it should be. This is how I would assess a true Private practice to function. No waiting lists; immediate attention to your concerns when booking appointments; a clean friendly and professional environment; comfortable setting (waiting room and surgeries) with amenable décor; a waiting room that is not crowded with patients; a clear explanation of any dental diagnosis; a choice of treatments; state-of-the-art technology and a satisfactory and comfortable outcome with regards to any treatments performed.

It is often the familiarity, when it comes to seeing the same clinician, that makes the choice for the patient. “I have been going there for 20 years”. Its the same reason why we choose the same hairdresser, or want to see the same doctor. It’s only when the familiar is taken away from us do we look around for something different (e.g. the dentist left the practice or retired). One has to think of how this familiarity was born. And maybe even review whether the reasons that originally made the patient choose the dentist still apply today.

Consistency is another choice maker. We all have seen businesses (especially restaurants) start up with exceptional customer service. Inevitably within a year, neither the staff nor the management are as enthusiastic to deliver a reasonable product or please the customer. It can be a similar situation in dentistry.

It is incorrect to assume that private dentistry is superior to that of NHS. It merely has the potential to provide a larger range of treatments with a huge array of materials. But these choices are often made by the dentist. It is easy to limit the treatment options and provide basic dental treatments for a higher cost. Embarrassingly, this happens in some places.

It is not always true that NHS treatments are cheaper. Fillings that have failed, for example, are not always replaced for free on the NHS. Most private practices will not charge if treatment fails within 1 year. Schemes such as Denplan Care often provide excellent value for money and are fully inclusive in the majority of treatments contained within their monthly cost package.

Finally, there is the matter of the time the dentist spends with the patient. This is important as it often reflects the quality of the treatment being performed – especially with fillings. This is often where NHS dentistry falls short, mostly due to high patient volume and inadequate time available for appointments.

In conclusion, NHS or Private ? It is an option that will be resolved differently for each individual. It will depend upon what they find important. What they define as value. How perceptive they are in the service they receive and options they are given. In dentistry, the destination is often similar but the journey can be very different. What was once commonly accepted may not quite cut the grade that is expected today. So if you are ever on the road you might notice that the car next to you is a Mercedez. And if you take the time to look around you, you may find it’s not the only one.

As a dental team we are always seeking to provide patient with the ability to maintain good oral health. As it is smile month from the 19th May 2014 we thought it would be a great excuse to provide our present and future patients with some information to help them gain a good oral hygiene routine at home. We hope you find the information below helpful.

The Periodontal Tissue is made up of the gingivae (gum), alveolar bone, cementum and the periodontal ligaments. All these structures act as one, supporting the teeth in the jaw and enable them to carry out their daily functions including biting, chewing, talking and maintaining the vertical height of the face. Periodontitis is the irreversible destruction of the periodontal tissue. This occurs through the inflammatory processes of body in reaction to the bacteria which is contained in plaque. This surrounds the teeth at the gingival margin (where the teeth contact the gum). Plaque is a sticky biofilm made up of glycoproteins, food debris and bacteria. This is why the regular removal of dental plaque is necessary to prevent the destruction of the periodontal tissues.

All advice given to patients from Dental Care Professionals in order to remove dental plaque is evidence based with a multitude of high level research papers backing them. In terms of preventative advice, dental hygiene therapist use ‘Delivering Better Oral Health’ which is a evidence based booklet put together by the department of health that help dental hygiene therapist direct their patient towards the best preventative oral hygiene routine .

When removing plaque, it is advised to brush the teeth twice a day for 2 minutes with either a manual or electric tooth brush. The brush should have a small amount of toothpaste on it that contains 1350 ppm fluoride.

When brushing with a manual tooth brush it should be angled with the bristles of the brush pointing at 45 degrees towards the gingival margins. This allows all the plaque that gathers between the gingiva and the tooth to be removed, maintaining the health of the gingivae and surrounding periodontal tissues. The brush should be moved using circular movement covering a couple of teeth at time that finish which a swiping action from the gingival margin. Strokes should also be overlapped so that all areas are covered.

If an electric toothbrush is used, the angulation of the brush used will vary depending on which make it is. You should consult your dentist or therapist for a demonstration of the proper use of these electric brushes.

After tooth brushing, the patient should, ideally, not rinse their mouth out afterwards but should rather just spit the remaining toothpaste out. This holds the toothpaste against the teeth, making its effects last longer.

In adult patients, it should be advised to use some kind of interdental cleaning (cleaning in between the teeth). This is because normal toothbrushes do not effectively remove plaque interdentally. These areas can become common sites where periodontitis can develop. There are a wide variety of cleaning aids that can be used: interdental brushes, wooden sticks, rubber sticks, water flossers, floss and flossettes. It is up to the patients’ preference what they feel more comfortable using in their mouth. Interdental cleaning should be carried out daily and be used in every interdental space.

Tooth brushing and interdental cleaning (apart from water flossing) are both forms of mechanical cleaning which are the best forms of cleaning teeth. This in combination effectively removes bacterial plaque from the teeth. Mouthwash, which is a form of chemical cleaning, can be used as an adjunct to mechanical cleaning, but should not be used as a replacement. Mouthwashes have many properties; preventing dental caries, combating the effects of xerostomia and preventing gum disease. Mouthwash should be used half an hour after tooth brushing to gain the maximum benefit from its components.

If it is possible to follow this oral hygiene routine, the patient will be at a lower risk of developing periodontitis. This is due to the plaque levels being maintained below a threshold that would ignite an inflammatory response. This means that the patients’ oral health remains healthy with minimal plaque and calculus deposits present.

This has been a highly promoted and competitive arena in the dental world for at least the last half a century. Dental materials are constantly evolving and improving amost every month.

The large players in the game have been companies like Dentsply, Ivolclar Vivadent, 3M and Voco to name just a few. These companies work closely with the dental surgeons to develop products that are becoming easier to place, last longer and look better.

Dentists like myself have a very large choice from which to trial products and choose which one works best in out hands.

Composites

These are the white filling materials that we use. Once they were only chosen as a replacement for the metal fillings (amalgams). But now composites are the primary choice for cosmetic corrections in the mouth. These corrections can vary from closing gaps between teeth to hiding/eliminating discolourations and even 1-step veneering in surgery, without the use of labs. These materials are improving in polishability, stain-resistance and longevity. With a multitude of dental courses being held all over the planet to introduce these materials to dentists as well as instruct them on how they should be applied, the popularity of composites are increasing daily. More recently they have started to be manufactured in dentine and enamel shades and a host of subtle staines and translucenies to match even the most complicated and demanding colour matches.

There are over 200 composites available in Great Britain today. Each is available in 20+ shades of white. Almost all are cured (set) by the use of a blue light.

Porcelains

Used in dental crowns, veneers, bridges and inlays. Undoubtably the primary cosmetic dental material of choice in the media today. The appearance and sheer beauty of some of these materials (when manufactured by a good laboratory technician) is unsurpassed so far (although composites are not too far behind). Once indirect restorations such as crowns and inlays were made from gold. But now most patients want a uniform white smile – that looks natural. Porcelains are available in many different forms. Feldspathic, pressed, milled, zirconia and bonded to metal. Their strength increases from the former to the latter. There are many different forms of each of these 5 types. Pressed, Milled and Zirconia are porcelains that are metal free. They can create a beautiful finish on teeth. Unfortunately all porcelain restorations are restricted in their finish based on the skill of the technician and the experience of the dentist that manufacture and prescribe them. Here are some properties and indications of these materials:

Feldspathic Porcelain – used in veneers only; fantastic aesthetics; very thin so minimal preperation (drilling) is required, cannot be used where the tooth is heavily discoloured to start with; prone to fracture if in heavy contact with opposing teeth.

Pressed Ceramics – used in crowns, veneers and inlays; stronger, more resistant to fracture; should ideally only be used on front teeth as chance of fracture if used on molars; Very good aesthetics.

Milled Porcelain – a more recent development in porcelains; infrastucture is made from a 3D scanned image of the prepared teeth and completely milled by an automated milling machine; used in all types of restorations including bridges; very strong, expensive; good easthetics; fine details still need to be added by technician following milling.

Zirconia – extremely strong, used in all types of dental restorations. more suitable for back teeth as slightly compromised aesthetic quality (unless produced by a exceptional technician); expensive.

Procelain bonded to metal – most commonly used porcelan material; used in all restorations except inlays; strongest materials in this list; these have a metal infrastructure; cosmetic finish is dependant on the type of porelain used and skill of dentist and technician (you could say that about almost anything though !).

Implants have been around for at least 30 years. In 1965 an implant system known as Branemark established the standards for implant dentistry. They published many research papers on the use of the system. It is now regarded as normal for any diploma or masters course in implantology to refer to this literature.

Over the last 15-20 years, however, we have seen many implant systems emerge. Some have remained with us to this day, and others have vanished through intense competition. What once seemed to be at the fringes of dental science has now come to be accepted as a standard option for replacing missing teeth. The use of titanium to replace human hard tissue had taken a leap into dentistry.

The question on most patient’s minds have always been ‘how long will it last ?’ and in some cases ‘how gruesome is the surgery ?’ The answer to the former question is that it is dependant on the sytemic health of the patient and local factors in the mouth. If placed correctly under aseptic/sterile conditions, in a mouth where the soft and hard tissues are healthy and there are adquate teeth to balance the force of the bite, there should be little reason why the implant shouldn’t last for at least 25 years or more.

Implant placement surgery is usually very staight forward. Depending on the preoperative levels of bone and the number of implants we are placing, it is normally less intrusive than an extraction. Soft tissue healing in the mouth is extremely fast in most people. Implant healing times are becoming faster and integration with the bone (osseointegration) better.

Implants in dentistry have a bright future. But the brightest future we should be looking forward to is one in which we get to look after our teeth so that they never require replacement.

Tooth whitening in dentistry has been around for many years. It has progressed through many generations of systems all of which, at one time or another, have claimed that their system worked best ! At 57fg Dental practice we have used at least 7 different systems over the past 10 years. Over this time we have become an accredited professional tooth whitening centre. The following are our conclusions after having performed hundreds of cases:

1. Power whitening (laser whitening) used by itself is not 100% successful. We encountered problems in predictability when this type of whitening was used by itself.

2. The duration of contact time of the bleach with the tooth surface (especially when carbamide peroxide is used) seems to be proportional to the whitening effect we observe. i.e. repeated sessions where we place the bleach solution against the tooth (5-8 hours a time – usually overnight) improves the whitening effect.

3. The reason for the above points are due to the bleach being able to create temporary porosities in the enamel surface. This is essential for the bleach to be able to get deeper into the structure of the enamel to whiten it fully. Slow acting low concentration bleaching is ideal for this effect.

So, in short, tooth whitening does work. Its limitations are seen only in the following circumstances:

– Crowns, veneers, and any fillings will not be affected by the bleach

– In cases where there is recesion or wear of enamel down to denine, whitening can be ineffective.

– If the bleachng instructions are not followed accurately a limited improvement may be seen.